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Outcome after blunt traumatic thoracic aortic laceration: identification of a high-risk cohort. Western Trauma
1Department of Surgery, University of Vermont, Burlington 05401, USA.
Insights
Age and coronary artery disease (CAD) predict worse outcomes for stable blunt traumatic thoracic aortic laceration (BTTAL) patients. Managing comorbidities and ensuring physiologic stability are crucial for improving survival in these critical cases.
Area of Science:
- Trauma Surgery
- Cardiovascular Surgery
- Emergency Medicine
Background:
- Blunt traumatic thoracic aortic laceration (BTTAL) presents complex management challenges.
- Identifying patient cohorts who may benefit from conservative or delayed treatment is critical.
- Pre-existing conditions and patient age are potential factors influencing outcomes.
Purpose of the Study:
- To investigate the predictive value of age and comorbidities on outcomes in patients with BTTAL.
- To identify factors associated with mortality and survival in stable BTTAL patients.
- To inform management strategies for BTTAL, including timing of repair and comorbidity management.
Main Methods:
- Retrospective review of BTTAL cases from 14 trauma centers over 11 years.
- Analysis of hospital and autopsy records for 395 confirmed BTTAL cases.
- Regression analysis to evaluate the impact of various factors on patient outcomes.
Main Results:
- Of 395 BTTAL cases, 233 were hemodynamically stable with a survival rate of 71.9%.
- Coronary artery disease (CAD) and increasing age were significantly associated with higher mortality.
- Beta-blocker use and normal blood pressure correlated with improved survival; delayed repair (>4 hours) did not increase mortality.
Conclusions:
- Age and CAD are significant predictors of adverse outcomes in stable BTTAL patients undergoing surgical repair.
- Effective management of comorbidities and associated injuries is essential for improving patient survival.
- Achieving physiologic stability prior to operative repair is a key recommendation for BTTAL management.
Background:
Specific cohorts of patients with blunt traumatic thoracic aortic laceration (BTTAL) might benefit from conservative or delayed management. We hypothesized that age and comorbidities would predict outcome.
Methods:
BTTAL data from 14 trauma centers over 11 years. Hospital and autopsy records of confirmed BTTAL were retrospectively reviewed. Regression analysis evaluated outcome by trauma indices, age, premorbidities, interventions, adjuvant therapy, and delay of repair.
Results:
Three hundred ninety-five cases of BTTAL were identified, 233 who were stable. Stable cohort survival was 71.9%. No trauma indices predicted outcome. Comorbidities, especially coronary artery disease (CAD), were associated with mortality. The use of beta-blocking agents and maintenance of normal blood pressure were associated with survival. Delay of >4 hours to operative repair was not associated with increased mortality. Increasing age was associated with higher mortality. Multivariate regression found CAD and AGE predictive of mortality (log odds formula: exp [-2.0858 + 0.0253(AGE) + 2.0428(CAD)]).
Conclusions:
AGE and CAD are associated with worse outcome in stable BTTAL patients undergoing operative repair. Treating comorbidities and managing associated injuries should be undertaken in stable BTTAL patients. Physiologic stability should be established before repair of BTTAL.